Common use of CLAIM SERVICES Clause in Contracts

CLAIM SERVICES. 2.01 Hawaii shall administer all Claims in accordance with the terms and conditions of the C&F Policies, this Agreement, and every applicable code, statute, law, rule, or regulation. 2.02 Hawaii shall perform the Claim Services and refer such Claims as may be designated in accordance with C&F's written standards, limitations, guidelines, instructions, policies, procedures, or limitations provided to Hawaii by C&F from time to time without the need to amend this Agreement. 2.03 Hawaii shall perform the following Claim Services: A. Examine all reported Claims (including incidents thereof which have been reported but for which no Claims have been made); and B. Maintain a Claim file for each reported Claim which shall be reviewable at any and all reasonable times by C&F; and C. Investigate all reported Claims as necessary using (at Hawaii's sole expense), if approved by C&F, a vendor from a list approved in writing by C&F; and D. Provide C&F, upon request, with a clear synopsis of the fact patterns of any Claim; and E. Determine and evaluate any coverage issues arising out of or in connection with such Claims, and to refer any actual or potential coverage issues to C&F with recommendations and, thereafter, to follow C&F's direction in the further administration of such Claims; and F. Prepare and send a reservation of rights letter; and G. Determine proper workers' compensation benefits due, if any, on compensable Claims; and H. Establish, pursuant to C&F's standards, reserves for all Claims; and I. Subject to the limitations contained herein, resist those Claims or adjust, handle, or settle to conclusion those Claims that C&F is legally obligated to pay or which C&F advises Hawaii it desires to pay, including the necessary preparation for and handling of any subrogation or contribution action which may inure to the benefit of C&F; and J. Make timely payment of Claims and ALAE through C&F's claims system in accordance with payment procedures established by C&F; and K. Coordinate a proper defense with counsel selected from a defense panel list approved in writing by C&F and reviewed annually with C&F; and L. Perform all necessary administrative and clerical work in connection with Claims; and M. Provide all forms necessary for the administration of Claims; and N. Perform all necessary services to collect Recoveries and properly credit Recoveries to the appropriate Claim file; and O. Collect, process, and report data in the manner required by the Internal Revenue Service for the purpose of preparing C&F's 1099 Miscellaneous Income filing for the Claims or ALAE payments made pursuant to this Agreement; and P. Provide such reports as C&F may request relating to Claims including, but not limited to, Claim payments made, reserves, and ALAE; and Q. Report suspected fraud as required by C&F or any applicable code, statute, law, rule, or regulation, and provide a copy of such report to C&F; and R. Upon C&F's request relating to a Claim or Claims, promptly provide C&F a captioned report identifying for each Claim: -- Claim number; -- Accident description; -- Claimant and injuries; -- Detailed description of outstanding issues; and -- Reserve calculation including loss and ALAE paid to date. The selection criteria for Claims to be reported is at the sole discretion of C&F. 2.04 To administer Claims hereunder, Hawaii shall use C&F's claims administration system or an interface transfer mechanism between the Hawaii's system and C&F's system which is compatible with C&F's computer systems and which complies with the established format and edit rules supplied to Hawaii by C&F. Hawaii agrees to provide C&F with system support for an interface of claims data between Hawaii's and C&F's systems. This data transfer shall include all payments, Recoveries, and reserve activities which have occurred and shall include a tie indicator for multiple claimants injured in a single occurrence, and such other information as the C&F may request from time to time. C&F reserves the right to alter or amend the format or edit rules as necessary, including but not limited to, the frequency of the data transfer.

CLAIM SERVICES. 2.01 Hawaii shall administer all Claims in accordance with the terms and conditions of the C&F Policies, this Agreement, and every applicable code, statute, law, rule, or regulation. 2.02 Hawaii shall perform the Claim Services and refer such Claims as may be designated in accordance with C&F's written standards, limitations, guidelines, instructions, policies, procedures, or limitations provided to Hawaii by C&F from time to time without the need to amend this Agreement. 2.03 Hawaii shall perform the following Claim Services: A. Examine all reported Claims (including incidents thereof which have been reported but for which no Claims have been made); and B. Maintain a Claim file for each reported Claim which shall be reviewable at any and all reasonable times by C&F; and C. Investigate all reported Claims as necessary using (at Hawaii's sole expense), if approved by C&F, a vendor from a list approved in writing by C&F; and D. Provide C&F, upon request, with a clear synopsis of the fact patterns of any Claim; and E. Determine and evaluate any coverage issues arising out of or in connection with such Claims, and to refer any actual or potential coverage issues to C&F with recommendations and, thereafter, to follow C&F's direction in the further administration of such Claims; and F. Prepare and send a reservation of rights letter; and G. Determine proper workers' compensation benefits due, if any, on compensable Claims; and H. Establish, pursuant to C&F's standards, reserves for all Claims; and I. Subject to the limitations contained herein, resist those Claims or adjust, handle, or settle to conclusion those Claims that C&F is legally obligated to pay or which C&F advises Hawaii it desires to pay, including the necessary preparation for and handling of any subrogation or contribution action which may inure to the benefit of C&F; and J. Make timely payment of Claims and ALAE through C&F's claims system in accordance with payment procedures established by C&F; and K. Coordinate a proper defense with counsel selected from a defense panel list approved in writing by C&F and reviewed annually with C&F; and L. Perform all necessary administrative and clerical work in connection with Claims; and M. Provide all forms necessary for the administration of Claims; and N. Perform all necessary services to collect Recoveries and properly credit Recoveries to the appropriate Claim file; and O. Collect, process, and report data in the manner required by the Internal Revenue Service for the purpose of preparing C&F's 1099 Miscellaneous Income filing for the Claims or ALAE payments made pursuant to this Agreement; and P. Provide such reports as C&F may request relating to Claims including, but not limited to, Claim payments made, reserves, and ALAE; and Q. Report suspected fraud as required by C&F or any applicable code, statute, law, rule, or regulation, and provide a copy of such report to C&F; and R. Upon C&F's request relating to a Claim or Claims, promptly provide C&F a captioned report identifying for each Claim: -- - Claim number; -- - Accident description; -- - Claimant and injuries; -- - Detailed description of outstanding issues; and -- - Reserve calculation including loss and ALAE paid to date. The selection criteria for Claims to be reported is at the sole discretion of C&F. 2.04 To administer Claims hereunder, Hawaii shall use C&F's claims administration system or an interface transfer mechanism between the Hawaii's system and C&F's system which is compatible with C&F's computer systems and which complies with the established format and edit rules supplied to Hawaii by C&F. Hawaii agrees to provide C&F with system support for an interface of claims data between Hawaii's and C&F's systems. This data transfer shall include all payments, Recoveries, and reserve activities which have occurred and shall include a tie indicator for multiple claimants injured in a single occurrence, and such other information as the C&F may request from time to time. C&F reserves the right to alter or amend the format or edit rules as necessary, including but not limited to, the frequency of the data transfer.